Quality Of Medical Aid Research Articles

Skilled nursing facility staffing shortages: Sources, strategies, and impacts on staff who stayed.

To examine skilled nursing facility (SNF) staffing shortages across job roles during the COVID-19 pandemic. We aimed to capture the perspectives of leaders on the breadth of staffing shortages and their implications on staff that stayed throughout the pandemic in order to provide recommendations for policies and practices used to strengthen the SNF workforce moving forward. For this qualitative study, we engaged a purposive national sample of SNF leaders (n = 94) in one-on-one interviews between January 2021 and December 2022. Using purposive sampling (i.e., Centers for Medicare & Medicaid quality rating, region, ownership) to capture variation in SNF organizations, we conducted in-depth, semi-structured qualitative interviews, guided a priori by the Institute of Medicine's Model of Healthcare System Framework. Interviews were conducted via phone, audio-recorded, and transcribed. Rigorous rapid qualitative analysis was used to identify emergent themes, patterns, and relationships. SNF leaders consistently described staffing shortages spanning all job roles, including direct care (e.g., activities, nursing, social services), support services (e.g., laundry, food, environmental services), administrative staff, and leadership. Ascribed sources of shortages were multidimensional (e.g., competing salaries, family caregiving needs, burnout). The impact of shortages was felt by all staff that stayed. In addition to existing job duties, those remaining staff experienced re-distribution of essential day-to-day operational tasks (e.g., laundry) and allocation of new COVID-19 pandemic-related activities (e.g., screening). Cross-training was used to cover a wide range of job duties, including patient care. Policies are needed to support SNF staff across roles beyond direct care staff. These policies must address the system-wide drivers perpetuating staffing shortages (i.e., pay differentials, burnout) and leverage strategies (i.e., cross-training, job role flexibility) that emerged from the pandemic to ensure a sustainable SNF workforce that can meet patient needs.

Identification of Surgeon Outliers to Improve Cost Efficiency: A Novel Use of the Centers for Medicare and Medicaid Quality Payment Program

BackgroundBundled payment programs for total joint arthroplasty (TJA) have become popular among both private and public payers. Because these programs provide surgeons with financial incentives to decrease costs through reconciliation payments, there is an advantage to identifying and emulating cost-efficient surgeons. The objective of this study was to utilize the Centers for Medicare and Medicaid Services (CMS) Quality Payment Program (QPP) in combination with institutional data to identify cost-efficient surgeons within our region and, subsequently, identify cost-saving practice patterns. MethodsData was obtained from the CMS QPP for total knee arthroplasty (TKA) and total hip arthroplasty (THA) surgeons within a large metropolitan area from January 2019 to December 2021. A simple linear regression determined the relationship between surgical volume and cost-efficiency. Internal practice financial data determined whether patients of identified surgeons differed with respect to x-ray visits, physical therapy visits, out-of-pocket payments to the practice, and whether surgery was done in hospital or surgical center settings. ResultsThere were 4 TKA and 3 THA surgeons who were cost-efficiency outliers within our area. Outliers and nonoutlier surgeons had patients who had similar body mass index, American Society of Anesthesiologists Physical Status Score, and age-adjusted Charlson Comorbidity Index scores. Patients of these surgeons had fewer x-ray visits for both TKA and THA (1.06 versus 1.11, P < .001; 0.94 versus 1.15, P < .001) and lower out-of-pocket costs ($86.10 versus $135.46, P < .001; $116.10 versus $177.40, P < .001). If all surgeons performing > 30 CMS cases annually within our practice achieved similar cost-efficiency, the savings to CMS would be $17.2 million for TKA alone ($75,802,705 versus $93,028,477). ConclusionsThe CMS QPP can be used to identify surgeons who perform cost-efficient surgeries. Practice patterns that result in cost savings can be emulated to decrease the cost curve, resulting in reconciliation payments to surgeons and institutions and cost savings to CMS.

Initiation and Receipt of Medication for Opioid Use Disorder Among Adolescents and Young Adults in 4 State Medicaid Programs in 2018: Improving Medicaid Quality Metrics.

Medications for opioid use disorder (MOUD) in youth can reduce harms but many youths do not receive MOUD. Improving quality metrics of MOUD among youth can advance interventions for youth with opioid use disorder (OUD). We relied on 2018 Medicaid claims data from California, Colorado, Massachusetts, and New Mexico. We calculated the percentage of youth with OUD included in the quality metric for initiation, and the percentage who initiated by state. We also calculated the percentage excluded from the quality metric for initiation because they have an existing episode of OUD care and their MOUD receipt. We compared the characteristics of those who initiated/received MOUD to those who did not and compared state estimates after adjusting for age and health conditions. Estimates of initiation exclude about half of the youth with OUD because they were in an existing episode of OUD care and could not be observed initiating. Among youth in a new episode of OUD care, only about 1 in 4 initiated and state estimates varied from 18.9% to 40.1%. Among youth with an existing episode of OUD care, more than half received MOUD and state estimates ranged from 35.2% to 71.3%. Youth who initiated MOUD or received MOUD with an existing OUD had more severe OUD but fewer co-occurring substance use disorders or mental or physical health diagnoses. After adjusting for age and health conditions, MOUD still varied substantially across states. Most youth with a new OUD diagnosis do not initiate MOUD but more than half of the youth in an existing OUD diagnosis receive MOUD. MOUD quality metrics that are disaggregated, adjusted, and inclusive of youth in an existing episode of care provide additional insight into opportunities to better support youth who might choose MOUD. State differences should be further studied for insight into policies that may affect MOUD.

UKRAINE AND THE WORLD IN CONDITIONS OF WAR: THE ROLE OF SCIENTIFIC, PROFESSION AND PUBLIC ORGANIZATIONS

UKRAINE AND THE WORLD IN CONDITIONS OF WAR: THE ROLE OF SCIENTIFIC, PROFESSION AND PUBLIC ORGANIZATIONS

Sociological research to study the quality of emergency medical aid to the population of the Republic of Uzbekistan by the method of questionnaire

In order to improve the system of emergency medical aid in the Republic of Uzbekistan, the issues of its availability and quality, as well as resources, technology and the results of the functioning of the system should be considered and analyzed taking into account the opinion of the heads of medical organizations, medical workers providing emergency medical care, as well as from the standpoint of study of patient satisfaction. To this end, a sociological study was conducted in 2021, the program of which included studying the opinions of the heads of medical organizations providing emergency medical care (stage 1) and employees of mobile ambulance teams (stage 2). Statistical and analytical methods were used. The data obtained allow us to note, in general, a positive assessment of the state of emergency medical care in the Republic of Uzbekistan by the heads of medical organizations. At the same time, according to the survey data, the medical workers themselves need to improve the working conditions of mobile teams, due to the significant volumes of non-core work, as well as the heavy work-load due to the high population density in the service area. The problems are exacerbated by the lack of informatization and automation of ambulance units, as well as the factor of “professional burnout” of personnel.

Character of wound microflora and resistance to antibiotics: monitoring results 2012–2020

The aim of the study was to improve the microbiological diagnosis of surgical infections, collect and analyze the data on the spectrum of surgical microflora and monitoring of antibiotic resistance in the period from 2012 to 2020.The research material was the separation of surgical wounds of patients, cultures of gram-negative and gram-positive bacteria isolated from the biological material of patients by the bacteriological method, the results of testing the sensitivity of bacterial cultures to antibiotics by diffusion into agar and using semi-automatic analyzers VITEK-2.A 9-year multicenter monitoring of the species composition of bacteria associated with wound infections revealed a high frequency of isolation of a number of conditionally pathogenic microorganisms – Escherichia spp., Klebsiella spp., Pseudomonas spp., Acinetobacter spp., Enterococcus spp., Streptococcus spp., Staphylococcus spp., Citrobacter spp., Proteus spp. In the period from 2012 to 2020, the amount of information entered into the computer database about these bacterial strains increased 1.4–2.0 times. Monitoring of bacterial resistance to antibiotics during this period showed a high level and dynamics to 3rd generation cephalosporins, carbapenems, and other classes. The lowest levels of resistance were found among the strains of Escherichia and the highest – Klebsiella, Pseudomonas and Acinetobacter. Staphylococci are characterized by high percentage of methicillin-resistant strains.Gram-negative (Escherichia, Klebsiella, Pseudomonas, Acinetobacter) and gram-positive (Enterococci, Streptococci, Staphylococci) are detected in the surgical patients with UTI with a high frequency. Surgical pathogens are characterized by a high level of resistance to 3rd generation cephalosporin, carbapenems, and other antibiotics. Long-term monitoring of bacterial resistance to antibiotics makes it possible to increase the effectiveness of laboratory diagnostics of surgical infections, to assess a resistance level of pathogens, an antibacterial therapy strategy and a medical aid quality.

Disaggregating Racial and Ethnic Data: A Step Toward Diversity, Equity, and Inclusion

Disaggregating Racial and Ethnic Data: A Step Toward Diversity, Equity, and Inclusion

Use of big data in schoolchildren’s career guidance practices for the medical profession

Introduction. The healthcare staffing deficiency affects negatively the availability and quality of medical aid and, consequently, the people’s quality of life and well-being. To eliminate this deficiency, it is proposed to use new formats and tools for schoolchildren’s professional orientation towards medical professions. Purpose of the study: to identify the potential of using big data for the development of schoolchildren’s career guidance practices in the field of medical labour. Materials and methods. The research was grounded on the identification of the pattern of the medical community’s personal and professional interests, as based on the data of the digital footprint of medical workers, first and final year students of Federal state-funded educational institution of higher education “Siberian State Medical University” (hereinafter SibSMU) [Russian Federation]. The technology “Pixel” borrowed from the social network “VKontakte” was used for the study. The study involved 947 persons whose personal data formed a basis for constructing a pattern of medical community interests. The study involved the methods of theoretical and structural analysis, predictive analytics and simulation modelling based on neural network data, as well as parsing. Results. A total of 6 attributes of the target audience segmentation (the medical community) were revealed; several identification features (explicit and implicit) reflecting the involvement of the social network “VKontakte” users in the medical community were found, analysed and differentiated on the basis of marketing approach. Using the “Pixel” technology, 3 sublevels reflecting the users’ explicit professional-interest category and 184 characteristics underlying their formation were found. Using the base of the social network “VKontakte”, a total of 79 million pages of users were processed according to the identification features. It was found that 79 thousand people matched the obvious professional interest reflecting the category “Medicine”. The authors undertook a search and analysis of the interests of the first-year (937 people) and final-year students of SibSMU as well as of professionals (medical doctors with more than 5 years of service record), following which a pattern of interests pertaining to the category of implicit identifying characteristics that included 14 categories was revealed. Conclusion. The research results showed that the use of big data and the analysis of the medical community’s digital footprint is an effective tool for the development of career guidance practices for schoolchildren and their parents. The identification of patterns of the medical community’s personal and professional interests can be used for the improvement of the efficiency of career guidance work with schoolchildren towards their motivated choice of the medical sphere as a career vector. The work with big data, complementing the existing career guidance approaches, is a due way to understand the preferences and interests of every schoolchild, which is important for achieving personalised support of professional self-identification.

Implications of missingness in self-reported data for estimating racial and ethnic disparities in Medicaid quality measures.

To assess the feasibility and implications of imputing race and ethnicity for quality and utilization measurement in Medicaid. 2017 Oregon Medicaid claims from the Oregon Health Authority and electronic health records (EHR) from OCHIN, a clinical data research network, were used. We cross-sectionally assessed Hispanic-White, Black-White, and Asian-White disparities in 22 quality and utilization measures, comparing self-reported race and ethnicity to imputed values from the Bayesian Improved Surname Geocoding (BISG) algorithm. Race and ethnicity were obtained from self-reported data and imputed using BISG. 42.5%/4.9% of claims/EHR were missing self-reported data; BISG estimates were available for >99% of each and had good concordance (0.87-0.95) with Asian, Black, Hispanic, and White self-report. All estimated racial and ethnic disparities were statistically similar in self-reported and imputed EHR-based measures. However, within claims, BISG estimates and incomplete self-reported data yielded substantially different disparities in almost half of the measures, with BISG-based Black-White disparities generally larger than self-reported race and ethnicity data. BISG imputation methods are feasible for Medicaid claims data and reduced missingness to <1%. Disparities may be larger than what is estimated using self-reported data with high rates of missingness.

RESULTS OF THE FIRST STAGE OF CLINICAL AUDIT IN THE UROLOGY DEPARTMENTS OF HEALTH CARE FACILITIES IN LVIV

Aim. The research aims at improving the quality of rendering medical care in the urology departments of health care facilities by conducting the clinical audit with advanced study of causes of dissatisfaction of patients with the medical service provided.&#x0D; Material and Methods. Sociological research included the questioning of 405 patients who were treated in the urology departments of the municipal nonprofit enterprise of the Lviv Regional Council "Clinical Emergency Hospital". The respondents estimated the quality of providing health care in the sphere of medical service, informational content, financing, the quality of diagnosis and treatment. Methods of structural-logical analysis, systemic approach and analysis, calculation of mean and relative values, calculation of satisfaction index with services provided are used in this work.&#x0D; Results and Discussion. The determination of the level of respondents' satisfaction with inpatient treatment showed that, in total, that the number of dissatisfied among the interviewed were 7.16±1.28 % persons. The focus-group of such persons was singled out: patients of active working age, financially - able, mainly with higher education, most often with diagnosis of urolithiasis, who suffered from pain syndrome, with late appealing for medical care (more than 24 hours), they were operated on and waited for the quick results of treatment, even despite the positive final result of treatment. These patients demanded more attention of a doctor, were dissatisfied with the work of paramedical personnel, conflicted with ward neighbors, had claims to availability and quality of medical equipment, sanitary state of premises of the department.&#x0D; Conclusions. The results of the clinical audit targeting the satisfaction of patients with medical services provided as one of the forms of receiving the patient feedback concerning the quality of medical aid, point out, on one hand, the appropriate level of availability of services, interpersonal attitudes, infrastructure, execution of technical demands as to quality and standard compliance by the staff of department. While, on the other hand, the audit results indicate the presence of dissatisfied with some certain services in the department. The focus-groups of dissatisfied make it possible to take into account the personal approaches in rendering medical aid to such categories of population, that in total will improve and increase the quality of providing medical services. Basing on the results of clinical audit, the recommendations as to the perfection of medical care management in the urology departments of health care facilities.

Clinical Recommendations of the Northwest Society for Enteral and Parenteral Nutrition, Interregional Association for Emergency Surgery, Russian Gastroenterological Association, Union of Rehabilitation Therapists of Russia and Russian Transplantation Society on Diagnosis and Treatment of Short Bowel Syndrome-Associated Intestinal Failure in Adults

Aim. Current clinical recommendations address the epidemiology, causes, clinical manifestations and pathogenesis of possible immediate and long-term complications, as well as the problematic issues related to treatment and rehabilitation of adult short bowel syndrome patients.Key points. Short bowel syndrome (SBS) is a symptom complex of impaired digestion caused by the reduction of small intestine absorptive surface and manifested by intestinal failure (IF) of various severity (maldigestion and malabsorption) developing into malnutrition and systemic somatogenic disorders. The vital strategic aspects of its treatment are the personalisation of liquid, macro- and micronutrients consumption as well as avoidance of intestinal failure- and parenteral nutrition-associated complications. Various nutritional support regimes and the indications for infusion therapy and maintenance parenteral nutrition are considered in this patient category, also in outpatient settings. To mitigate the dependence on intravenous fluid- and nutrient administration and attain enteral autonomy in SBS-IF patients, the use of recombinant glucagon-like peptide-2 (GLP-2) is justified as exerting a pronounced trophic effect on the epithelial regenerative potential as well as structural and functional adaptation of intestinal mucosa. The SBS-IF patients prescribed with home parenteral nutrition and/or their caregivers should be trained in a special programme that covers the catheter care, preparation of infusion solutions and nutrient mixture container, infusion pump operation as well as the prevention, recognition and management of complications. The main referral indications for small bowel transplantation (SBT) are: fast-progressing cholestatic liver disease-complicated irreversible intestinal failure; thrombosis of two or more central venous conduits used for parenteral nutrition; recurrent catheter-associated bloodstream infection.Conclusion. Current recommendations on diagnosis and treatment as well as the developed criteria of medical aid quality assessment are applicable at different levels of healthcare.

A Postacute Care Function Process Quality Measure for the Collection of Standardized Self-Care and Mobility Data: Development, Implementation, and Quality Measure Scores

ObjectiveTo describe the development of and quality measure scores for the cross-setting postacute care function process quality measure that requires the collection of standardized self-care and mobility data at admission and discharge and at least 1 function goal. DesignDescription of the development and implementation of the quality measure and the associated standardized self-care and mobility data elements. Descriptive analyses of quality measure scores for the first calendar year using data from the Minimum Data Set, the Inpatient Rehabilitation Facility Patient Assessment Instrument, the Long-Term Care Hospitals (LTCH) Continuity Assessment Record and Evaluation Data Set, and Outcome and Assessment Information Set. Setting15,127 skilled nursing facilities (SNFs), 1129 inpatient rehabilitation facilities (IRFs), 414 LTCHs, and 10,352 home health agencies (HHAs) in the United States. ParticipantsIn total there were 9,216,943 stays/quality episodes (N = 9,216,943), including 2,084,774 SNF Medicare fee-for-service patient stays, 493,209 IRF Medicare patient stays, 161,714 patient stays, and 6,477,246 Medicare and Medicaid quality episodes. InterventionsNot applicable. Main Outcome MeasuresScores for the cross-setting postacute care function process quality measure. ResultsThe mean process quality measure scores for SNFs, IRFs, LTCHs, and HHAs were 95.5%, 99.7%, 99.1%, and 95.8, respectively. The 10th percentile scores for SNFs, IRFs, LTCHs, and HHAs were 88.5%, 99.3%, 98.4%, and 89.4, respectively, indicating that at least 90% of postacute care providers submitted the standardized data for a large proportion of their patients. Mean quality measure scores did not vary by provider characteristics. ConclusionsMost SNFs, IRFs, LTCHs, and HHAs submitted the self-care and mobility data, resulting in high quality measure scores during the first year of implementation. The availability of the standardized self-care and mobility data across postacute care settings offers the opportunity to compare the characteristics and functional outcomes of patients treated in postacute care.

Diagnosis and Treatment of Irritable Bowel Syndrome: Clinical Recommendations of the Russian Gastroenterological Association and Association of Coloproctologists of Russia

Aim. Current clinical recommendations accentuate current methods for the diagnosis and treatment of irritable bowel syndrome (IBS).Key points.IBS is a functional bowel disorder manifested with recurrent, at least weekly, abdominal pain with the following attributes (any two leastwise): link to defecation, its frequency or stool shape. The symptoms are expected to persist for at minimum three months in a total six-month follow-up. Similar to other functional gastrointestinal (GI) disorders, IBS can be diagnosed basing on the patient symptoms compliance with Rome IV criteria, provided the absence of potentially symptom-causative organic GI diseases. Due to challenging differential diagnosis, IBS can be appropriately established per exclusionem, with pre-examination as follows: general and biochemical blood tests; tissue transglutaminase IgA/IgG antibody tests; thyroid hormones test; faecal occult blood test; hydrogen glucose/ lactulose breath test for bacterial overgrowth; stool test for enteric bacterial pathogens and Clostridium difficile A/B toxins; stool calprotectin test; abdominal ultrasound; OGDS, with biopsy as appropriate; colonoscopy with biopsy. The IBS sequence is typically wavelike, with alternating remissions and exacerbations often triggered by psychoemotional stress. Treatment of IBS patients includes dietary and lifestyle adjustments, various-class drug agents prescription and psychotherapeutic measures.Conclusion. Adherence to clinical recommendations can facilitate timely diagnosis and improve medical aid quality in patients with different clinical IBS variants.

DEFINING THE ONTOLOGICAL STATUS OF LABOUR PRODUCTIVITY IN HEALTH CARE

he present research touches upon the problem of comprehension of the concept «labor productivity» as applied to the field of healthcare in comparison with other categories and the corresponding indicators, used in the assessment of the medical organization personnel activity. As methodological basis the ideas in the field of labor economics, conceptual apparatus and theoretical bases of which have proved their efficiency in the solution of the tasks of development of the organizations of different branch affiliation act. The statement that labor productivity in public health services is connected with the transfer of knowledge and technologies from industrial sphere to medicine, requiring the interpretation of concepts and conceptual apparatus in relation to the considered branch is taken as the basis. In modern conditions of high intensity of work of medical organizations at simultaneous necessity of observance of obligatory requirements to quality and safety of medical aid, rational use of resources, the demand for formation of scientifically grounded approaches to labor productivity estimation in healthcare is realized by authors by means of development of an integrated index of labor productivity estimation. The present research can be considered in the development of the theory of labor productivity as applied to the branch of health care taking into account its orientation on rendering qualitative and safe medical aid. The offered by the author approach to the estimation of the given indicator allows to reflect not only quantitative (output, labor input) or cost estimation of labor productivity, but also takes into account complexity, intensity of work of the employees, and also an estimation of a degree of achievement of productivity (quality) of their activity. Its novelty is seen in the mutual conditionality of medical, social and economic evaluation of the effectiveness of the use of labor resources of the employees of medical organizations.

Geneti c Traits of Brachiocephalic Atherosclerosis

Background. According to the World Health Organization, the atherosclerosis development depends on the quality of life and lifestyle (60 %), genetic (20 %), environmental factors (10 %) and quality of medical aid (5 %). The routes to defeat atherosclerosis generally and certain systemic enzyme disorders in particular pertain in research into the population genetic predispositions to this pathology.Materials and methods.A comparative study of genetic predispositions to malignant brachiocephalic atherosclerosis analysed the renin—angiotensin system gene association in 60 patients. Th e renin—angiotensin system allelic and polymorphic loci haplotype frequencies have been determined.Results and discussion. Patients with atherosclerotic brachiocephalic vascular lesions revealed a statistically significant frequency of the AGT gene’s allele C involved in coronary heart disease development.Conclusion. Th e study suggests a putative involvement of the angiotensinogen system genes in mediating the development of brachiocephalic atherosclerosis and coronary heart disease

Advancing Health Equity for Medicaid Beneficiaries by Adding Colorectal Cancer Screening to the Centers for Medicare and Medicaid Services Adult Core Set

Advancing Health Equity for Medicaid Beneficiaries by Adding Colorectal Cancer Screening to the Centers for Medicare and Medicaid Services Adult Core Set

Foreign body in the esophagus as a reason to assess the medical aid quality during the forensic medical examination

Was to investigate in detail the case of a combination of esophageal injury and aortic aneurysm from the standpoint of the perspective of medical care. It was established that the circumstances of the improper provision of medical care in this case were the subjective nature in the form of insufficient and incorrect provision of it. It is shown that continuous training of doctors and mid-level medical workers within the continuing medical education is a gurantee of proper medical care.

СВЯЗЬ ОБЩЕСТВЕННОГО НЕДОВЕРИЯ К ВЛАСТИ С ИНФОРМИРОВАННОСТЬЮ О COVID-19: ФЕНОМЕН COVID-ДИССИДЕНТСТВА

In this study, we analyze the correlation between trust in government and official information with individual compliance to recommended measures, and between attitudes to government measures and people's behavior during the Covid-19 pandemic. We identified a group of respondents who refused categorically to believe in the COVID-19 pandemic in Russia – COVID-19 dissidents. They not only deny the pandemic but also refuse to comply with pandemic rules and restrictions. Then, based on seven national samples covering a combined total of 40,700 people in all regions of Russia, we established a link between the level of distrust of the public sector and the level of COVID-19 dissidence by means of linear regression. We proved that COVID-19 dissidents don’t trust official statistics and believe in low infection risks. They provide low evaluation of the medical aid quality which leads to underestimation of the risk of being infected and COVID-19 compliance rules. We recommend governments consider restoring citizens’ trust as one of the priorities in fighting the pandemic, alongside battling misinformation that feeds conspiracy beliefs. The level of public trust in government decisions is a critical factor that speeds up mass vaccinations and contributes to a quick exit from the pandemic crisis.

The technique of simultaneous laparoscopic operations in the treatment of gallstone disease and hiatal hernia

Annotation. Aim of work – to evaluate the quality of medical aid for the regular and simultaneous treatment of patients with gallstone disease in combination with a hiatal hernia. To evaluate the safety of simultaneous operations in the treatment of such patients. Determine advantages and disadvantages of both treatment strategies. Assess the ergonomics of laparoscopic surgery techniques. For sampling the database, statistic collected at the laparoscopic surgery unit of the Volynian Regional Clinical Hospital was used. The number of patients was 332. Patients were formed into two groups: the group of simultaneous laparoscopic treatment (laparoscopic cruroraphy with Toupet fundoplication and laparoscopic cholecystectomy with advanced surgery technique) – the first group of 126 people, and the group with only one operation (laparoscopic cruroraphy) was performed – the second group of 206 patients. The method that was chosen in first group (simultaneous laparoscopic treatment with advanced technique) allowed to prevent re-hospitalization, one more operation, and all associated risks (surgical, anesthesiologycal). Though the cost was a slight increased time of surgery (52 minutes versus 41), as well as a slightly increased the average hospital stay (3.25 days versus 3.1 days) comparing to a single surgery group. Complication rate didn`t increased significantly (5.5% in the first group versus 6.3% in the second group), with zero mortality in both groups. These data allow us to notice the safety and value of this treatment method and to continue its research and testing. The method can be linked to increasing the efficiency of medical care by reducing the number of hospitalizations, the total hospital stay, and reducing the overall cost of treatment, minimizing the cost of dealing with the complications.

EXPERIENCE OF NEURAL NETWORK MODELING IN MANAGING THE ACHIEVEMENT OF CRITERIA FOR A NEW MODEL OF A MEDICAL ORGANIZATION THAT USES LEAN TECHNOLOGIES

Nowadays the scientific developments connected with increase of readiness of the medical institutions, rendering primary medical and sanitary aid, to work with application of methods and tools of lean technologies for increase of level of availability and quality of medical aid to the population of Russia acquire urgency. The aim of the study is to assess the prognostic importance of common neural network models to analyze the value components of the reception of a local therapist, affecting the level of satisfaction with the quality of medical care, from the position of management to achieve the criteria of a new model of a medical organization using lean technologies. The following types of neural network models were studied: based on a multilayer perceptron, a radial basis function, and a generalized regression neural network. Models based on multiple linear regression equations were used as a control group of networks. In total, 50 artificial neural networks were obtained and analyzed. The effectiveness of neural network models was evaluated based on the following parameters: the ratio of standard deviations of the forecast error and the source data, as well as the Pearson correlation between the observed and predicted indicators of the model. Among the studied neural network models, models based on a multi-layer perceptron and generalized regression neural networks have the highest quality of prediction, which makes them promising for use in systems that monitor and predict the structure of the value component of the main processes in medical organizations for patients. The proposed neural network models can become the basis for creating information management systems that monitor the achievement of performance criteria for a new model of a medical organization that uses lean technologies.